| Objective:To know the distribution of the disability elderly unmet need of long term care and the disability elderly survival status,depressive symptoms,cognitive function and social participation,analyze the impact of unmet need of long term care on the survival status,depressive symptoms,cognitive function and social participation of the disabled elderly people,to explore the relationship among unmet need of long term care,depressive symptoms,cognitive functioning,and social participation status for disabled elderly,identifying the impact of unmet need of long term care on the health of disability elderly and the mechanisms that influence them.In order to provide a strategies for the disabled elderly to enjoy effective long term care services,provide ideas for the health management measures for the disabled elderly.Methods:Based on The Chinese Longitudinal Healthy Longevity Survey(CLHLS),the elderly aged 65 years and above were selected as the study subjects,and statistical was analyzed by SPSS26.0 and Amos27.0.The distribution of unmet need of long term care,depressive symptoms,cognitive function and social participation of the elderly with different characteristics was analyzed by?~2.The survival status of the elderly with disabilities was analyzed by life table methods;the Kaplan-Meier method was used to plot the survival curves of the elderly with different satisfaction of the long term care need.The impact of the unmet need of long term care need on the survival status of the elderly with disabilities was analyzed using Cox regression models.The effects of unmet need of long term care on the depressive symptoms,cognitive function and social participation status of the elderly with disabilities were analyzed using the unconditional logistic stepwise regression model;the common method bias test was conducted using Harman’s single-factor test;the correlation analysis of the main variables was conducted using the Spearman correlation;the Bootstrap method was used to analyze the relationship between unmet need of long term care,social participation,depressive symptoms and cognitive function.Results:1.The unmet need of long term care rate among older adults with disabilities in the2018 cross-sectional survey was 47.1%.There were differences in the distribution of the unmet need of long term care among disabled elderly by marital status and chronic disease status.the higher the literacy level of disabled elderly,the lower satisfaction rate of the long term care need;the poorer the economic status,the higher satisfaction rate of the long term care need;and the poorer the self-rated health status,the higher satisfaction rate of the long term care need.2.The life span table method shows that with the increase of survival time,the survival rate of the disabled elderly gradually decreases.Log Rank and Breslow tests showed that the difference in survival rates between disabled elderly with met and unmet need of long term care was statistically significant,the disabled elderly with unmet need of long term care experiencing a faster decline in survival than those with met long term care need.Unmet need of long term care was a risk factor for survival(OR=1.153,95%CI:1.004～1.324)among disabled elderly.3.The detection rate of depressive symptoms in disabled elderly in the 2018 c ross-sectional survey was 65.3%,with unmet need of long term care being a risk f actor for depressive symptoms in disabled elderly(OR=1.859,95%CI:1.541～2.243).Living in the countryside(OR=1.242,95%CI:1.010～1.527),living alone(OR=1.491,95%CI:1.040～2.138),living in a nursing home(OR=1.586,95%CI:1.116～2.252),fair self-rated economic status(OR=1.352,95%CI:1.080～1.693),poor self-rated economic status(OR=1.487,95%CI:1.032～2.143),fair self-rated health status(OR=2.359,95%CI:1.936～2.874),and poor self-rated health status(OR=5.176,95%CI:3.927～6.823)wer e all risk factors for the development of depressive symptoms in disabled elderly.4.The detection rate of impaired cognitive function in disabled elderly in the2018 cross-sectional survey was 63.5%,with unmet need of long term care being a risk factor for impaired cognitive function in disabled elderly(OR=1.830,95%CI:1.507～2.222).Age 75 years～(OR=2.094,95%CI:1.165～3.761),85 years～(OR=3.323,95%CI:1.878～5.879),95 years～(OR=8.769,95%CI:4.914～15.649),female(OR=1.420,95%CI:1.161 to 1.737),Living in a rural area(OR=1.500,95%CI:1.216～1.850),self-rated fair economic status(OR=1.477,95%CI:1.172～1.861),self-rated fair hea lth status(OR=1.294,95%CI:1.047～1.599),self-rated poor health status(OR=1.763,95%CI:1.356～2.292)were all risk factors for the development of cognitive impairmen t in disabled elderly.Educational attainment junior and high school(OR=0.648,95%CI:0.493～0.852),university and above(OR=0.511,95%CI:0.334～0.784),married(OR=0.612,95%CI:0.469～0.800),chronic illness(OR=0.804,95%CI:0.656～0.985)wa s a protective factor for the development of cognitive impairment in disabled elderl y.5.The detection rate of no social participation among disabled elderly in the 2018 cross-sectional survey was 43.2%.Regression analysis showed that unmet need of long term care were a risk factor for no social participation among disabled elde rly(OR=1.204,95%CI:1.004～1.445).85 years～(OR=2.262,95%CI:1.235～4.143),95years～(OR=4.390,95%CI:2.384～8.085),female(OR=1.710,95%CI:1.401～2.089),living i n the countryside(OR=2.154,95%CI:1.743～2.662),self-reported average economic sta tus(OR=1.408,95%CI:1.111～1.785),self-reported poor economic status(OR=1.565,95%CI:1.113～2.202),and poor self-rated health(OR=1.820,95%CI:1.425～2.324)w ere all risk factors for no social participation among disabled elderly;Educational at tainment junior and high school(OR=0.698,95%CI:0.521～0.936),university and abov e(OR=0.402,95%CI:0.234～0.691),and chronic illness(OR=0.696,95%CI:0.578～0.839)were protective factors for no social participation in disabled elderly.6.The results of the correlation analysis showed that long term care need was negatively correlated with social participation(r=-0.131,P<0.01),cognitive functioning(r=-0.188,P<0.01)and positively correlated with depressive symptoms(r=0.249,P<0.01)respectively;social participation was negatively correlated with depressive symptoms(r=-0.152,P<0.01)and with cognitive functioning(r=0.432,P<0.01)and depressive symptoms were negatively associated with cognitive functioning(r=-0.180,P<0.01).The need of long term care affect cognitive function of disabled elderly people through three pathways:The need of long term care affect cognitive function through social participation,the need of long term care affect cognitive function through depressive symptoms,and the need of long term care affect cognitive function through a chain mediator between social participation and depressive symptoms.Chain mediators have statistical significance in male disabled elderly,while social participation plays an independent mediating role between the need of long-term care and cognitive function in female disabled elderly.Conclusions:1.There is still an unmet demand for long term care for the disabled elderly,and there are differences in the unmet need of the disabled elderly with different characteristics.Therefore,it is necessary to develop personalized elderly care services according to the different characteristics of the disabled elderly to meet their elderly care needs.2.The survival rate of the disabled elderly gradually decreases with the increase of survival time;the detection rate of depressive symptoms and cognitive impairment of the disabled elderly is high,and social participation is low;depressive symptoms,cognitive impairment and social participation of the disabled elderly vary according to their characteristics.3.Unmet needs of long term care are detrimental to the survival of the elderly with disabilities,increasing the risk of depressive symptoms and impaired cognitive function,reducing the social participation of the elderly with disabilities,and threatening the health status of the elderly with disabilities.4.The unmet need of long term care can reduce cognitive functioning not only by reducing the social participation of older people with disabilities,but also by increasing depressive symptoms in older people with disabilities.Social participation and depressive symptoms mediate the chain between unmet long term care needs and cognitive functioning and are gender-specific. |
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